|By C. Nicholas Walz, MD
Midwest Community Health Associates
Diabetes affects approximately 8 percent of the U.S. population or nearly 16 million adults. It is estimated that the overall economic burden attributed to diabetes in the U.S. in 2001 exceeded $100 billion.
Anything that can be done to lessen complications, decrease lost time at work, and make people live longer, healthier lives is important. The main thing that can be done to impact diabetes and its complications is to control all aspects of the syndrome that is diabetes.
We must not only control the blood sugar in diabetes but we must control high blood pressure, reach ideal cholesterol levels, prevent kidney complications and avoid lifestyles that accelerate these complications.
Diabetes is defined as a fasting blood sugar greater than 124 or a blood sugar greater than 200, at anytime. Control of diabetes means keeping the fasting glucose below 110 and two-hour-after-meal sugars below 140.
Another measure of control is maintaining the hemoglobin A1C (Hgb A1C) or glycosylated hemoglobin below 7 percent (ideally below 6.5 percent). The Hgb A1C is basically an overall average measure of a patient’s blood sugar level over a 6-8 week period. Keeping this test below 7 percent with oral medication and/or insulin has proven very important in preventing the complication of diabetes.
These complications mainly involve the blood vessels and the nerves. Blood vessel complications include strokes, heart attacks, eye problems, kidney problems and decreased circulation to the extremities. Nerve complications are primarily a condition called neuropathy, which involves pain and tingling in the limbs and occasionally problems with the stomach.
The key to control is not just controlling the blood sugar. Doctors now know we have to control blood pressure and cholesterol as well.
Not only must we control parameters, but we must control them even better than in non-diabetic patients. This means that a blood pressure reading of 140/85 may be acceptable in a non-diabetic patient, but the goal in a diabetic is 130/80 or lower.
The same is true of cholesterol. Diabetics and people with heart disease need to keep the bad cholesterol (LDL cholesterol) level below 70 as opposed to the non-diabetic level of 100.
Another test that physicians now monitor in diabetics is urine micro-albumin. This measures the presence of protein in the urine, and if high, indicates that the kidney has been affected by diabetes. If excess micro-albumin is present, a blood pressure medicine called an ace inhibitor has been found to protect kidney health.
Finally, and probably most important, is control of lifestyle. Anything that adds to the risk of heart disease or vascular disease adds to the risk in a diabetic. Diabetics cannot smoke or drink alcohol to excess. And, of course, diabetics need to work toward ideal body weight. The incidence of diabetes is rising in this country partly because of the increase in obesity.
Diabetics tend to get very frustrated with the amount of medicine they have to take. As stated previously, most diabetics eventually are on one to three medications for their sugar, one to three medications for blood pressure and medication for their cholesterol. It is not unusual to be on seven or eight medications. Unfortunately, this is essential to decrease the risk of diabetic complications.
The good news about all of this is that we know if we maintain the above-mentioned control, a diabetic can feel better and expect nearly the same longevity and quality of life as non-diabetics. The key is control.
C. Nicholas Walz, M.D. is a doctor of Family Medicine at MCHA, serving the Montpelier office.